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The waiting game

How to avoid a medical manslaughter investigation

Dr Beverley Ward advises

The death of a patient is tragic in itself, but potentially devastating if a police investigation for manslaughter follows. This is an issue which is facing more doctors, GPs included.

Fortunately, while there are an increasing number of manslaughter investigations, in the MDU’s experience 10% or fewer result in a criminal prosecution. And only about 25% of those cases prosecuted (around 2.5% overall) result in conviction.

The investigation alone can be lengthy and invariably take a considerable toll on the GP involved emotionally and professionally and on the practice. Police investigations rarely take less than six months and can take a number of years. During that time, because of the seriousness of the allegations and the nature of primary care, GPs can usually expect to have restrictions on practice imposed, by the GMC and by NHS England, at the very least.

While it’s not unusual for a tragedy to occur following a combination or sequence of mistakes, coupled by system failures, sadly, it is often the conduct of an individual doctor which is scrutinised.

The following steps can help GPs to reduce the risk of facing a criminal investigation or to know how to respond if the worst happens:

1. Work within your capabilities. If you’re not sure about something, seek advice or supervision.

2. Understand and follow any local procedures that are part of the clinical governance framework. Be prepared to justify any deviation from national guidelines.

3. Conduct and document a full and complete clinical assessment of patients that will include negative as well as positive symptoms and signs. It’s easy to miss something when under time pressure.

4. Think about patient safety in your CPD planning. Some of the mistakes that lead to prosecutions have happened before, and raising your personal awareness of them will have obvious benefits, so seek out courses, conferences and initiatives relevant to general practice.

5. Be flexible in your thought processes. When treating a patient be ready to stand back and consider all available information. If something doesn’t seem quite right it probably isn’t and you may need to consider a wider differential diagnosis, or a referral.

6. Embed patient safety initiatives in your practice, and encourage colleagues to follow suit. Join the NHS England ‘Sign up to safety’ campaign which has five principles at its heart - putting safety first, continually learning, being honest, collaborating (take a lead role in collaborative learning) and being supportive (helping others to learn why things go wrong, and how to put them right). One example could be prescribing systems designed to identify and flag up potential drug errors or interactions, such as cross referencing with patients’ known allergies.

7. Flag up systems or practices you believe are unsafe and address them. For example, if there aren’t enough resources or poor system design means you cannot provide a safe and effective service to patients, raise this formally at your practice meetings and take a personal interest in ensuring there is progress.

8. Make sure serious incident investigations are properly conducted, with accurate minutes that deal with the relevant issues. Identify the problem and solution, rather than the blame. This will help the whole practice team to learn any lessons from serious incidents in the interests of patient safety. It could also help to preventing a recurrence of mistakes that could lead to a manslaughter investigation.

If something does go wrong and a patient dies or is seriously injured

  • Get advice from your medical defence organisation at the earliest opportunity.
  • Don’t try to produce a statement/information for any investigation without the notes or advice from your medical defence organisation or a solicitor instructed by them.
  • Never make the mistake of thinking that the police won’t know the subject matter. Any interviews will likely be conducted by skilled officers.
  • For the best of reasons you are very unlikely to have experience of a police interview. Be ready to ask for and follow your solicitor’s advice. It is your right to consult your solicitor and it does not make you look guilty if you do.

Dr Beverley Ward is a medico-legal adviser at the MDU

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Readers' comments (6)

  • More anodyne and totally useless advice from the MDOs who are totally detached from the reality at the coalface.

    1 Work within your capabilities: GPs are constantly being pressured to take on extra risk beyond everyday practice but when for example we refused to prescribe hormones for gender dysphoria even the GMC threatened us.
    2 Understand and follow any local procedures: All very well and good but patients don’t come neatly wrapped up ready to respond to reams and reams of NICE guidance, much of which is so controversial of late it has had to be amended. Even Pulse ran a issue questioning if NICE was a laughing stock!
    3 Conduct and document a full and complete clinical assessment: Seems reasonable until you realise we only have 10 minutes per patient so we have little choice but to keep notes concise. Patients often have agendas that conflict with this defensive practice. Lawyers on the other had can take months to draft a basic contract.
    4 Think about patient safety in your CPD planning: reasonable but a lot of the events reported are complex multi-level systems failures.
    5 Be flexible in your thought processes: You seem to be suggesting we refer more when all the top-down pressure is on referral management and reducing tests. DOH is in total denial about us being woefully under-resourced compared to most of Europe.
    6 Embed patient safety initiatives in your practice: This is a gimmick - the junior doctors have been screaming this for the last year and just been walked all over. The government have not interest in safety because it is expensive and are actively pushing practices to fail.
    7 Flag up systems or practices you believe are unsafe and address them: Most of the high-risk systems are beyond are control and imposed from the top, for example shoddy software that regularly crashes, the disastrous sale of patient services to Serco and the constant pressure to take on ‘shared care’ drugs with no extra resource. We’ve recently seen that Junior Doctors have no statutory whistleblowing protection because it was ‘a conscious choice of parliament.’
    8 Make sure serious incident investigations are properly conducted: We already participate in Significant Event Analysis but most of these relate to unusual events or the tide of vexatious complaints. GPs need to concentrate on normal care for common problems. More often than not things go wrong because medical staff are overwhelmed.

    What has become clear is that the medico-legal system in the UK has grown unchecked into an abusive and exploitative industry that acts with impunity and not in the best interests of patients. Persecution of medical staff is a gross breach of human rights but the MDOs are staying silent because they have a conflict of interest and make huge profits from this rapidly growing area of law. The MDOs should have spoken out against all this but they’ve chosen not to. Perhaps it’s time for them to bear some responsibility for the monster they have helped create?

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  • Just do not become a GP or even a doctor. I would not do medicine again. It is impossible never to make a mistake. We are human. How many accountants kill themselves each year?

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  • Anonymous 12.35, absolutely brilliant and accurate analysis of many of my own thoughts while reading the article. I too am experiencing the increasing divorce from hard reality that the MDOs continue to espouse with their pious platitudes.

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  • "Just do not become a GP or even a doctor. I would not do medicine again."

    Absolutely spot on!
    So far this year
    1 Ombudsman case against me
    2 On going negligence case
    3 Practice in Special Measures

    Result--I hate coming to work. My family life is impacted. I just want to do something else--but have no option but to carry on or just self destruct.

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  • Has Dr Ward ever practised as a medico in the real world of medicine? We seem to be ruled by some healthcare mafia where managers and politicians have no accountability and doctors are left to carry the much for whistle-blowing..
    Well said 12:35..couldn't put it better..

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  • This article appears to be written by someone sitting in an Ivory tower . Completely oblivious to the reality of day to day general practice . It just compounds the fear and anxiety felt by grassroots GP's and offers no substantial or sustainable solutions .

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